Provider Demographics
NPI:1699265850
Name:LORI L VANYO MD FACS INC
Entity type:Organization
Organization Name:LORI L VANYO MD FACS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-766-1600
Mailing Address - Street 1:1910 ROYALTY DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3021
Mailing Address - Country:US
Mailing Address - Phone:909-766-1600
Mailing Address - Fax:909-766-1601
Practice Address - Street 1:1910 ROYALTY DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3021
Practice Address - Country:US
Practice Address - Phone:909-766-1600
Practice Address - Fax:909-766-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABV4898447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty